Therapeutic strategies to counteract antibiotic resistance in MRSA biofilm-associated infections

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as one of the leading cause of persistent human infections. This pathogen is widespread and is able to colonize asymptomatically about a third of the population causing moderate to severe infections. It is currently considered the most common cause of nosocomial infections and one of the main cause of death in hospitalized patients. Due to its high morbidity and mortality rate and its ability to resist to most antibiotics on the market, it was defined a “superbug”. Its ability to form biofilm on biotic and abiotic surfaces seems to be the primarily responsible of MRSA antibiotic resistance and pervasiveness. Importantly, more than 80% of bacterial infections are biofilm-mediated. Biofilm formation on indwelling catheters, prosthetic devices and implants is recognized as cause of serious chronic infections in hospital environment. In this review we discussed the most relevant literature of the last five years concerning the development of synthetic small molecules able to inhibit biofilm formation or to eradicate or disperse pre-formed biofilms in the fight against MRSA diseases. The aim is to provide guidelines for the development of new anti-virulence strategies based on the knowledge so far acquired, and, to identify the main flaws of this research field, which did not allow to obtain new anti- MRSA drugs market-approved able to act against biofilm-associated infections